Parent Questionnaire 2000-2001 questionnaire.pdf · FOSTRSON Foster son SISTER Sister BROTHER...

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Project: 873 Parent Questionnaire 2000-2001 1. SAMPLE I.D. __________________________ 2. INTERVIEWER I.D. NO. __________________________ THE FOLLOWING STATEMENT MUST BE READ TO ALL RESPONDENTS PRIOR TO THE START OF THE INTERVIEW: Study of Instructional Improvement University of Michigan - ISR 426 Thompson Street Room 1070 Ann Arbor, Michigan 48106-1248 "This interview is confidential and completely voluntary. If we should come to any question that you do not wish to answer, let me know and we will go on to the next question. For quality control purposes I will be tape recording this interview."

Transcript of Parent Questionnaire 2000-2001 questionnaire.pdf · FOSTRSON Foster son SISTER Sister BROTHER...

Project: 873

Parent Questionnaire 2000-2001

1. SAMPLE I.D. __________________________ 2. INTERVIEWER I.D. NO. __________________________ THE FOLLOWING STATEMENT MUST BE READ TO ALL RESPONDENTS PRIOR TO THE START OF THE INTERVIEW:

Study of Instructional Improvement

University of Michigan - ISR 426 Thompson Street Room 1070 Ann Arbor, Michigan 48106-1248

"This interview is confidential and completely voluntary. If we should come to any question that you do not wish to answer, let me know and we will go on to the next question. For quality control purposes I will be tape recording this interview."

Key to Household Roster Relationships

In order to standardize the relationship names that you record in the household roster, please follow this key to common relationships you are likely to encounter. Anyone in the household who does not fit into one of these categories should be listed as “OTHER.” WIFE Wife HUSBAND Husband DAUG Daughter SON Son GFRIEND Girlfriend BFRIEND Boyfriend STDAUG Stepdaughter STSON Stepson DAUINLAW Daughter in law SONINLAW Son in law FOSTRDAU Foster Daughter FOSTRSON Foster son SISTER Sister BROTHER Brother SISINLAW Sister in law BROINLAW Brother in law MOTHER Mother FATHER Father MOINLAW Mother in law FAINLAW Father in law GDAU Granddaughter GSON Grandson GGDAU Great granddaughter GGSON Great grandson GMOTHER Grandmother GFATHER Grandfather GGMOTH Great Grandmother GGFATH Great Grandfather NIECE Niece NEPHEW Nephew AUNT Aunt UNCLE Uncle COUSIN Cousin DAUFRND Daughter of friend SONFRND Son of friend NONREL Nonrelative OTHER Anyone who doesn’t fit into one of the above categories

1 INTRODUCTION

1. ID: _ _ _ _ _ _ _ _ _ _ _ _

2. IWER #: _ _ _ _

Study of Instructional Improvement 2000–2001 Parent Questionnaire

SCREENING—SUGGESTED INTRODUCTION: Hello, may I speak with [PARENT]? If parent is available: Hello [NAME], this is ______calling on behalf of the Study of Instructional Improvement at the University of Michigan. As you may know, [CHILD] is participating in an educational research study that is being conducted at [CHILD’S SCHOOL]. At the beginning of this school year we mailed you information about the study. You may remember a special permission form for the Study of Instructional Improvement. I would like to do a short phone interview with the adult most involved with [CHILD’S] education. Would that be you?

If parent is not available: This is ______calling on behalf of the Study of Instructional Improvement at the University of Michigan. As you may know, [CHILD] is participating in this educational research study that is being conducted at [CHILD’S SCHOOL]. At the beginning of this school year we mailed information about the study. (If explicit consent was obtained, mention the parent consent form that was signed and returned.) I would like to do a short phone interview with the adult most involved with [CHILD’S] education. Who is the adult most involved with [CHILD’S] education? Is that person available to come to the phone? (As needed, start IW or set appointment for callback).

WHEN RESPONDENT IDENTIFIED—SUGGESTED INTRODUCTION: We are conducting this study to learn more about school and home experiences of young children. The information we gather will be used to help teachers and policymakers improve the school experiences of students across the country. As a token of our appreciation for your help, we will send you a check for $10 for your participation. REQUIRED STATEMENT: "This interview is confidential and completely voluntary. If we should come to any question that you do not wish to answer, let me know and we will go on to the next question. For quality control purposes I will be tape recording this interview."

2 HOUSEHOLD ROSTER

EXACT TIME NOW: ____________________ 3. I have a couple questions about the people who live with you and [CHILD]. How many people live in your

household, including yourself and [CHILD]? Please include all adults and children currently living in your household.

_____ _____ NUMBER OF PERSONS IN HH 4. GO TO HH ROSTER AND COMPLETE 4a–c.

4a. What is your relationship to [CHILD]? 4b. What is your age? 4c. MARK CORRECT BOX FOR SEX OR VERIFY.

5. I need a listing of the age, sex, and relationship to you of the other members of your household, starting

with your child. We don't need names, just each person's relationship to you and to [CHILD].

5a. What is [CHILD's] relationship to you? 5b. What is [CHILD’s] age? 5c. MARK CORRECT BOX FOR SEX OR VERIFY.

6 – 15. For the next person, what is that person’s relationship to you? a. What is (his/her) relationship to [CHILD]? b. How old is (he/she)?

c. MARK CORRECT BOX FOR SEX OR VERIFY.

INTERVIEWER INSTRUCTION: COMPLETE ITEMS ON ROSTER, AS NEEDED. AFTER R COMPLETES LIST, PROBE TO VERIFY THAT THERE IS NO ONE ELSE IN THE HOUSEHOLD.

3 ROSTER

RELATION TO INF

RELATION TO CHILD AGE SEX (F / M)

PERSON #

4. INFORMANT

4a. 4b. 4c. 1 (R)

5.

5a. CHILD 5b.

5c. 2 (CHILD)

6. 6a. 6b. 6c. 3

7.

7a. 7b. 7c. 4

8.

8a. 8b. 8c. 5

9.

9a. 9b. 9c. 6

10.

10a. 10b. 10c. 7

11.

11a. 11b. 11c. 8

12.

12a. 12b. 12c. 9

13.

13a. 13b. 13c. 10

14.

14a. 14b. 14c. 11

15.

15a. 15b. 15c. 12

MARK, IF APPLIES: NE

R IALWAYS MARK ONE:

R IHO

R IHO

R

P

N

INTERVIEWER CHECKPOINT

ITHER R NOR PARENT IN HH HAS SPOUSE/PARTNER LIVING IN HH

S PARENT OF CHILD.

S NOT PARENT OF CHILD AND HH ROSTER SHOWS NO PARENT IN USEHOLD.

S NOT PARENT OF CHILD AND HH ROSTER SHOWS A PARENT IN USEHOLD.

4

FAMILY ACTIVITIES 16. I'd like to talk with you about [CHILD's] activities with family members. In a typical week, how often

do you or any other family member do the following things with [CHILD]—not at all, once or twice a week, 3 to 6 times a week, or every day?

How often do you or NOT AT ALL ONCE OR TWICE 3–6 TIMES EVERY DAY any other family member: A WEEK A WEEK

16a. read books to [CHILD]? 16b. tell stories to [CHILD]? 16c. listen to [CHILD] read? 16d. sing songs with (him/her)? 16e. involve [CHILD] in setting the table? 16f. play card games, board games or

counting games with (him/her)? 16g. count together with [CHILD]?

17. About how many books does [CHILD] have in your home now, including library books? Please only

include books that are for children.

__________ NUMBER OF BOOKS 18. Other than at school, how often did [CHILD] read books or magazines in the past week—

would you say never, once or twice a week, 3 to 6 times a week, or every day?

19. In the past week at home, how often did [CHILD] talk about something that (he/she) had

read—would you say never, once or twice a week, 3 to 6 times a week, or every day?

8. DON'T KNOW 9. REFUSED

1. NEVER 2. ONCE OR TWICE

3. 3–6 TIMES 4. EVERY DAY

8. DON'T KNOW 9. REFUSED

1. NEVER 2. ONCE OR TWICE

3. 3–6 TIMES 4. EVERY DAY

5 20. Other than at school, how often did [CHILD] practice adding and subtracting in the past week—

would you say never, once or twice a week, 3 to 6 times a week, or every day?

21. Other than at school, how often did [CHILD] count money and change in the past week—

would you say never, once or twice a week, 3 to 6 times a week, or every day?

22. Other than at school, how often did [CHILD] practice multiplication in the past week— would you say never, once or twice a week, 3 to 6 times a week, or every day?

8. DON'T KNOW 9. REFUSED

1. NEVER 2. ONCE OR TWICE

3. 3–6 TIMES 4. EVERY DAY

8. DON'T KNOW 9. REFUSED

1. NEVER 2. ONCE OR TWICE

3. 3–6 TIMES 4. EVERY DAY

8. DON'T KNOW 9. REFUSED

1. NEVER 2. ONCE OR TWICE

3. 3–6 TIMES 4. EVERY DAY

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SCHOOL EXPERIENCES 23. Now I'd like to ask about [CHILD]'s experiences before and after starting school. Did [CHILD] ever

attend any of the following programs prior to Kindergarten: YES NO

23a. Head Start?..........................................................................……… 23b. Day-care program?...................................................…………......

23c. State-supported program for four-year-olds?................................. 23d. Nursery school, preschool, or early childhood program, other than those you already mentioned? .............................…...

YES NO

24. Did [CHILD] ever attend a . . .

24a. half-day Kindergarten?.....................………………………….. 24b. full-day every day Kindergarten?..............................................

24c. alternating-day Kindergarten?………………………………….

SKIP TO QUESTION 26

INTERVIEWER CHECKPOINT CHILD IS IN KINDERGARTEN. PROCEED TO QUESTION 25. CHILD IS NOT IN KINDERGARTEN. PROCEED TO QUESTION 24.

7 25. Is [CHILD] in full-day every day, half-day, or alternating-day Kindergarten? 26. Has [CHILD] ever been held back a grade in school?

SKIP TO IWER CHECKPOINT ON THIS PAGE 27. What grades did (he/she) repeat? MARK ALL THAT APPLY. 28. What were the reasons (he/she) repeated this grade/these grades? MARK ALL THAT APPLY.

9. REFUSED 8. DON'T KNOW

2. IMMATURE; ACTS TOO YOUNG

3. FREQUENTLY ABSENT

5. FOURTH 1. KINDERGARTEN

2. FIRST 3. SECOND 4. THIRD

0. NO 1. YES

3. ALTERNATING-DAY 1. FULL-DAY 2. HALF-DAY

1. ACADEMIC PROBLEMS

4. MOVED TO A DIFFERENT SCHOOL

5. OTHER

INTERVIEWER CHECKPOINT CHILD IS IN KINDERGARTEN.

SKIP TO QUESTION 31. ALL OTHERS PROCEED TO QUESTION 29.

8 29. Has [CHILD] ever skipped a grade in school? SKIP TO QUESTION 31 30. What grades did he or she skip? MARK ALL THAT APPLY. 31. Since starting Kindergarten, how many times, if any, has [CHILD] changed schools? ____________ NUMBER 32. Now I have some questions about special services that some children receive. Has [CHILD] ever

received services for special education, such as a special education classroom, resource room, a learning disabilities teacher-consultant, or speech and language therapy?

SKIP TO QUESTON 34 33. Who provided these services for special education—the school, a community agency, or someone

else? MARK ALL THAT APPLY. 34. Has [CHILD] ever receiv

or social or behavioral pro S

0. NO 1. YES

1. SCHOOL 3. SOMEONE ELSE

1. YES

5. FOURTH 1. KINDERGARTEN

2. FIRST 3. SECOND 4. THIRD

9. REFUSED 8. DON'T KNOW 0. NO 1. YES

2. COMMUNITY AGENCY

ed mental health services, such as counseling or help with attention blems?

KIP TO QUESTION 36

0. NO

9 35. Who provided these services for mental health—was it the school, a community agency, or someone

else? MARK ALL THAT APPLY. 36. Has [CHILD] ever receiv

speaking or understanding

SK 37. Who provided these servi

agency, or someone else? 38. Has [CHILD] ever receiv

or reading problems, Title

SK

39. Who provided these servi

someone else? MARK A

1. SCHOOL 3. SOMEONE ELSE

1. YES

1. SCHOOL

1. YES

1. SCHOOL

QUESTIONS 32,

SKIP TO QUEST ALL OTHERS CO

2. COMMUNITY AGENCY

ed English as a Second Language (ESL) services, such as help with English?

IP TO QUESTION 38

ces for English as a Second Language—was it the school, a community

0. NO

3. SOMEONE ELSE

2. COMMUNITY AGENCY

ed services for other learning problems, such as tutoring for math I services, or tutoring due to poor grades?

IP TO IWER CHECKPOINT ON THIS PAGE

ces for other learning problems—was it the school, a community agency, or LL THAT APPLY.

0. NO

3. SOMEONE ELSE

2. COMMUNITY AGENCY

INTERVIEWER CHECKPOINT

34, 36, AND 38 ARE ALL MARKED "NO."

ION 41.

NTINUE TO QUESTION 40.

1040. How well do you think the school meets the special needs of your child—does it not at all meet (his/her)

needs, meet only minimum needs, adequately meet (his/her) needs, more than adequately meet (his/her) needs?

41. Now I have a few questions 42. What is your race —are you

Native Hawaiian or other P 43. Is (CHILD) of Hispanic or 44. What is (his/her) race—is h

American, Native Hawaiian

3. ADEQUATELY MEETS

4. MORE THAN ADEQUATELY MEETS

1. DOES NOT AT ALL MEET NEEDS

1. YES

1. AMERICAN INDOR ALASKAN NAT

1. YES

4. NATIVE HAWAIIAOTHER PACIFIC ISLA

1. AMERICAN INDOR ALASKAN NAT

4. NATIVE HAWAIIAOTHER PACIFIC ISLA

8. DON’T KNOW

8. DON’T KNOW

2. MEETS MIN. NEEDS

DEMOGRAPHICS

about your background. Are you of Hispanic or Latino/a origin?

American Indian or Alaskan Native, Asian, Black or African American, acific Islander, White, or Other? MARK ALL THAT APPLY.

Latino/a origin?

e/she American Indian or Alaskan Na or other Pacific Islander, White, or O

0. NO

IAN IVE

5. WHITE

3. BLACK OR AFRICAN AMERICAN

2. ASIAN

0. NO

N OR NDER

IAN IVE

5. WHITE

2. ASIAN

N OR NDER

9. REFUSED

9. REFUSED

6. OTHER (SPECIFY):

tive, Asian, Black or African ther? MARK ALL THAT APPLY.

3. BLACK OR AFRICAN AMERICAN

6. OTHER (SPECIFY):

1145. What is [CHILD]'s date of birth? ____ ____ /____ ____ / ____ ____ MONTH DAY YEAR 46. What is your current marital status— are you married, divorced, widowed, separated, not married but

living with someone in a marriage-like relationship, or have you never married?

3. WIDOWED 1. MARRIED

2. DIVORCED 4. SEPARATED

5. NOT MARRIED BUT IN MARRIAGE-LIKE RELATIONSHIP

6. NEVER MARRIED

8. DON'T KNOW 9. REFUSED

R IS PARENT OF CH

R IS NOT PARENT OHOUSEHOLD. ASK Q R IS NOT PARENT OHOUSEHOLD. ASK Q

R

N

P

INTERVIEWER CHECKPOINT

ILD. ASK QUESTIONS 47–54 ABOUT R.

F CHILD AND HH ROSTER SHOWS NO PARENT IN UESTIONS 47–54 ABOUT R.

F CHILD AND HH ROSTER SHOWS A PARENT IN UESTIONS 47–54 ABOUT PARENT.

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47. What is the highest level of education (you /[CHILD’S PARENT]) completed? DO NOT READ CATEGORIES.

48. N

(y

S 49. W

S

3. HIGH SCHOOL DIPLOMA OR EQUIV

2. 9TH–11TH GRADE

1. 8TH GRADE OR LESS

EMPLOYMENT

ext, I'd like to ask some questions about employment and jobs. During the past week, did ou /[CHILD’S PARENT]) work at a job for pay?

KIP TO QUESTION 52

ere (you /[CHILD’S PARENT]) on leave or vacation from a job?

KIP TO QUESTION 52

6. SOME COLLEGE NO DEGREE

7. ASSOCIATE’S DEGREE

8. BACHELOR’S DEGREE

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

4. VOCATIONAL/TECH PROG— NO DEGREE

5. VOCATIONAL/TECH PROG— DEGREE

9. GRAD OR PROF SCHOOL—NO DEGREE

10. MASTER’S DEGREE

11. PHD OR OTHER ADVANCED DEGREE

13 50. Have (you /[CHILD’S PARENT]) been actively looking for work in the past four weeks?

SKIP TO QUESTION 52 51. What were (you / [CHILD’S PARENT]) doing most of last week—would you say you were keeping

house or caring for children, going to school, retired, unable to work, or something else?

52. W

w _ 53. W

d_

_

_ _ 54. W

_ _

_

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

3. RETIRED 2. GOING TO SCHOOL

4. UNABLE TO WORK

1. KEEPING HOUSE/ CHILD CARE

ALL SKIP TO IWER CHECKPOINT ON NEXT PAGE

hat kind of work are (you /[CHILD’S PARENT]) doing now or did (you/[CHILD’S PARENT]) do hen (you/[CHILD’S PARENT]) last worked?

_________________________________ JOB TITLE—WRITE TWO OR MORE WORDS.

hat are/were (your /[CHILD’S PARENT]’S) most important activities or duties on this job? What o/did (you /[CHILD’S PARENT]) actually do at this job? PROBE (PO) FOR MORE DETAIL. _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

hat business or industry is/was this in? PROBE (PI) FOR MORE DETAIL.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

5. SOMETHING ELSE—PLEASE SPECIFY ____________________________________

8. DON'T KNOW

9. REFUSED

14

55. What is the highest level oDO NOT READ CATEG

R IS PARENT OF CH(SPOUSE/PARTNER

R IS NOT PARENT HOUSEHOLD. ASK

R IS NOT PARENT ASK QUESTIONS 5

R

N

P

2. 9G

6. SOME COLLEGE NO DEGREE

4. VOCATIONAL/TENO DEGR

9. GRAD OR PROF SCDEGREE

11. PHD OR OTHER ADEGREE

INTERVIEWER CHECKPOINT NEITHER R NOR PARENT IN HOUSEHOLD HAS (SPOUSE/PARTNER) LIVING IN HOUSEHOLD.

IF MARKED, SKIP TO QUESTION 63. IF NOT MARKED, GO TO NEXT CHECKPOINT.

INTERVIEWER CHECKPOINT

ILD. ASK QUESTIONS 55-62 ABOUT R'S ).

AND HH ROSTER INDICATES THERE IS NO PARENT IN QUESTION 55-62 ABOUT R'S (SPOUSE/PARTNER).

AND HH ROSTER INDICATES A PARENT IS IN HOUSEHOLD. 5–62 ABOUT PARENT’S (SPOUSE/PARTNER).

f education your (spouse/partner) has completed? ORIES.

IF P USE THE FOLLOWING QUESTION.

What is the highest level of education ([CHILD’S PARENT’S] (spouse/partner)) has completed?

3. HIGH SCHOOL DIPLOMA OR EQUIV

TH–11TH RADE

1. 8TH GRADE OR LESS

7. ASSOCIATE’S DEGREE

8. BACHELOR’S DEGREE

CH PROG— EE

5. VOCATIONAL/TECH PROG—DEGREE

HOOL—NO

10. MASTER’S DEGREE

DVANCED

15 56. Now I have some questions about your (spouse’s/partner's) employment. During the past week, did

(your spouse/partner) work at a job for pay?

IF P USE THE FOLLOWING QUESTION.

Now I have some questions about ([CHILD’S PARENT’S] (spouse/partner)) employment. During the past week, did ([CHILD’S PARENT’S] (spouse/partner)) work at a job for pay?

SKIP TO 60 57. Was (your spouse/partner) on leave or vacation from a job?

IF P USE THE FOLLOWING QUESTION.

Was ([CHILD’S PARENT’S] (spouse/partner)) on leave or vacation from a job? SKIP TO 60 58. Has (your spouse/partner) been actively looking for work in the past four weeks?

IF P USE THE FOLLOWING QUESTION. Has ([CHILD’S PARENT’S] (spouse/partner)) been actively looking for work in the past four weeks?

SKIP TO 60

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

16

59. What was (your spouse/partner) doing most of last week? Would you say keeping house or caring for children, going to school, retired, unable to work, or something else?

IF P USE THE FOLLOWING QUESTION.

What was ([CHILD’S PARENT’S] (spouse/partner)) doing most of last week? Would you say keeping house or caring for children, going to school, retired, unable to work, or something else?

60. W

la

_ 61. W

d_

_

_ _

3. RETIRED

1. KEEPING HOUSE/ CHILD CARE

A

hat kind of work is (your spousst worked?

IF P USE

What kind([CHILD’S

__________________________

hat are/were (his/her) most impo at this job? PROBE (PO) FO__________________________

__________________________

__________________________

__________________________

2. GOING TO SCHOOL

LL SKIP TO QUESTION 63

e/partner) doing now or did (your spouse/p

THE FOLLOWING QUESTION.

of work is ([CHILD’S PARENT’S] (spous PARENT’S] (spouse/partner)) do when (h

_______ JOB TITLE—WRITE TWO O

ortant activities or duties on this job? WhaR MORE DETAIL. __________________________________

__________________________________

__________________________________

__________________________________

4. UNABLE TO WORK

9. REFUSED

5. SOMETHING ELSE—PLEASE SPECIFY

8. DON'T KNOW

artner) do when (he/she)

e/partner)) doing now or did e/she) last worked?

R MORE WORDS.

t does/did (he/she) actually

_________________

_________________

_________________

_________________

1762. What business or industry is/was this in? PROBE (PI) FOR MORE DETAIL.

______________________________________________________________________________ ______________________________________________________________________________

FAMILY RESOURCES 63. These next questions are about food and clothing. I am going to read you several statements that

people have made about their food situation. For these statements, please tell me whether the statement was never true, sometimes true, or often true for your household in the last 12 months.

63a. "We worried whether our food would run out before we got money to buy more."

Would you say that was never true, sometimes true, or often true for your household in the last 12 months?

63b.

63c.

64. Now I'

me whthe last

64a.

3. OFTEN 2. SOMETIMES

1. NEVER

"The food that we bought just didn't last and we didn't haveWould you say that was never true, sometimes true, or often12 months?

"[CHILD] was not eating enough because we just couldn't aWould you say that was never true, sometimes true, or often

m going to read some similar statements about clothing situaether the statement was never true, sometimes true, or often 12 months.

"I didn't have enough money to buy ([CHILD]/my children(he/she/they) need(s) for school." Would you say that was often true for your household in the last 12 months?

3. OFTEN 2. SOMETIMES

3. OFTEN 2. SOMETIMES

3. OFTEN 2. SOMETIMES

8. DON'T KNOW

money to get more true for your hous

fford enough food true in the past 12

tions. For each, pltrue for your house

) the kind of shoes never true, sometim

9. REFUSED

." ehold in the last

1. NEVER

8. DON'T KNOW

9. REFUSED

." months?

1. NEVER

8. DON'T KNOW

9. REFUSED

ease tell hold in

and clothes es true, or

1. NEVER

8. DON'T KNOW

9. REFUSED

18 64b. "([CHILD]/My children) had to stay home from school sometimes because (he/she/they) did not have warm enough clothes to wear." Would you say that was never true, sometimes

true, or often true in the past 12 months?

64c.

65. Finally

househ 66. During

Childresometi

67. During

months

3. OFTEN 2. SOMETIMES

1

1. NEVER

([CHILD]/My children) get(s) teased about the clothes (he/don't have the money to provide any other clothes." Would sometimes true, or often true in the past 12 months?

I have a few questions about your finances. During 2000, dold receive income from a full- or part-time job?

2000, did you or anyone in your household receive Aid to Fn—sometimes called AFDC or ADC—or Temporary Assis

mes called TANF?

SKIP T

2000, how long did someone in your household receive AF, three to five months, six to eight months, or nine to twelve

3. OFTEN 2. SOMETIMES

0. NO 1. YES 8. DON'T K

0. NO . YES 8. DON'T

3. 6–8 MO. 2. 3–5 MO. 4. 9–12 MO.

8. DON'T KNOW

she/they) wear(s) toyou say that was n

id you or anyone in

amilies with Depetance for Needy Fa

O 68

DC or TANF? Wa months?

NOW

KNOW

9. REFUSED

school but I ever true,

1. NEVER

8. DON'T KNOW

y

ndm

s i

9

9

9. REFUSED

our

ent ilies,

t one to two

. REFUSED

. REFUSED

1. 1–2 MO.

8. DON'T KNOW

9. REFUSED

1968. During 2000, did you or anyone in your household receive food stamps?

SKIP TO 70 69. During 2000, how long did you or anyone in your household receive food stamps? Was it one to two

months, three to five months, six to eight months, or nine to twelve months?

0. NO 1. YES 9. REFUSED 8. DON'T KNOW

3. 6–8 MO. 2. 3–5 MO.

4. 9–12 MO.

1. 1–2 MO.

TURN PAGE

8. DON'T KNOW

9. REFUSED

20 70. In 2000, what was the total household income from all sources? (IF R IS UNSURE OF THE AMOUNT,

PROBE: What is your best estimate?)

3. $5,000 - $9,999

1. NONE

EXACT TIM

GO TO RESPONDENT NAME AND ADDRE

98. DON'T KNOW

99. REFUSED

2. UNDER $5,000

6. $20,000 - $24,999

4. $10,000 - $14,999

5. $15,000 - $19,999

9. $35,000 - $39,999

7, $25,000 - $29,999

8. $30,000 - $34,999

10. $40,000 - $49,999

11. $50,000 - $74,999

12. $75,000 - $99,999

13. $100,00 – 199,000

14. $200,000 or more

E NOW: ____________________

SS INFORMATION PAGE

RESPONDENT NAME AND ADDRESS INFORMATION PAGE

71. This completes the interview. Thank you very much for your time and your help with our research. We would like to send you a check for $10 as a token of our appreciation. For that reason, would you spell your first & last name for me and give me your address? 71a.

FIRST NAME 71b.

LAST NAME

71c.

NUMBER AND STREET ADDRESS 71d.

APT. NUMBER 71e.

CITY

71f.

STATE 71g.

ZIP CODE

72. LENGTH OF INTERVIEW: __________________________MINUTES 73. LENGTH OF EDIT: __________________________MINUTES 74. INTERVIEW COMPLETED IN

75. INTERVIEW COMPLETED 76. DATE OF INTERVIEW: __________________________ 77. FINAL RESULT CODE: __________________________

1. ENGLISH 2. SPANISH

1. BY PHONE 2. FACE-TO-FACE

Notes: